Can single disease payment system based on clinical pathway reduce hospitalization costs in rural area? A case study of uterine leiomyoma in Anhui, China

Abstract Background Single disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from different perspectives. This study aimed at evaluating the effect of the scheme in rural county public hospitals within Anhui, a typical province of China,using uterine leiomyoma as an example. Methods The study data were extracted from the data platform of the New Rural Cooperative Medical Office of Anhui Province using stratified-random sampling. Means, constituent ratios and coefficients of variations were calculated and/or compared between control versus experiment groups and between different years. Results The total hospitalization expenditure (per-time) dropped from 919.08 ± 274.92 USD to 834.91 ± 225.29 USD and length of hospital stay reduced from 9.96 ± 2.39 days to 8.83 ± 1.95 days(P < 0.01), after CP-based SDP had implemented. The yearly total hospitalization expenditure manifested an atypical U-shaped trend. Medicine expense, nursing expense, assay cost and treatment cost reduced; while the fee of operation and examination increased (P < 0.05). The expense constituent ratios of medicine, assay and treatment decreased with the medicine expense dropped the most (by 4.4%). The expense constituent ratios of materials, ward, operation, examination and anesthetic increased,with the examination fee elevated the most (by 3.9%).The coefficient of variation(CVs) of treatment cost declined the most (− 0.360); while the CV of materials expense increased the most (0.186). Conclusion There existed huge discrepancies in inpatient care for uterine leiomyoma patients. Implementation of CP-based SDP can help not only in controlling hospitalization costs of uterine leiomyoma in county-level hospitals but also in standardizing the diagnosis and treatment procedures

Research on Ranking Evaluation Models of Safety Risk in Productive Enterprises based on the Perspective of Supervision

AbstractSupervision with risk highlights the key area, enterprises and period. It is great for finding the principal contradiction in supervision of safe production, to improve the efficiency of government's regulation and further to realize the optimal configuration of the limited supervisory force from local government. This paper establishes the risk evaluation index system of incident and disaster for manufacturing enterprises based on the systematic investigation and analysis of 209 enterprises in T city, Shandong Province by referring to many research outcomes of scholars abroad and domestic, related laws and regulations and professional standards, choosing 6 B indexes which include 35C indexes according to the four characteristics and core objective of inherent risk level of manufacturing enterprise, safety regulation level, records of hidden dangers and punishments and accident occurrences. This paper also applies analytic hierarchy process(AHP) to determine the weight of every evaluation indexes, and make mathematics modelling according to the determined index system and weight, then use the model to evaluate and classify the risks of the 209 enterprises of T city Shandong Province, and finally propose measures of safety risk ranking supervision of production for local government according to the result of classification

Tensile Characteristics and Fracture Mode of Frozen Fractured Rock Mass Based on Brazilian Splitting Test

Frozen fractured rock mass is often encountered during the implementation of geotechnical engineering in cold regions. The tensile strength parameters of frozen rock play an important role in the construction of rock slopes involving tensile failure. In order to study the tensile characteristics of a frozen fractured rock mass in a cold region, original rock specimens were mined and processed in the Yulong Copper Mine, and artificial, frozen fractured marble specimens were made. The effects of different ice-filled crack angles, lengths, and widths on the force–displacement curve and the tensile strength of frozen rock were studied by laboratory Brazilian splitting experiments and RFPA3D, and the evolution law of the tensile strength of frozen rock was revealed. At the same time, wing crack initiation and cracking mode after tensile failure were analyzed by high-speed camera; the whole process of the Brazilian splitting of frozen rock was reconstructed, and the development of microcrack initiation in frozen rock was analyzed. The following conclusions were drawn from the test results: the frozen rock specimens have typical brittle-failure characteristics. The tensile strength of frozen rock decreases gradually with the increase in the width and length of ice-filled cracks, and decreases first and then increases with the increase in the angle of the ice-filled crack. The ice-filled crack incurs damage first, and then the wing cracks start from the tip of the ice-filled crack and extend continuously. The tensile strength of frozen rock is significantly affected by the angle and length of ice-filled cracks

Suppression of Enteric Bacteria by Bacteriophages: Importance of Phage Polyvalence in the Presence of Soil Bacteria

Bacteriophages are widely recognized for their importance in microbial ecology and bacterial control. However, little is known about how phage polyvalence (i.e., broad host range) affects bacterial suppression and interspecies competition in environments harboring enteric pathogens and soil bacteria. Here we compare the efficacy of polyvalent phage PEf1 versus coliphage T4 in suppressing a model enteric bacterium (<i>E. coli</i> K-12) in mixtures with soil bacteria (<i>Pseudomonas putida</i> F1 and <i>Bacillus subtilis</i> 168). Although T4 was more effective than PEf1 in infecting <i>E. coli</i> K-12 in pure cultures, PEf1 was 20-fold more effective in suppressing <i>E. coli</i> under simulated multispecies biofilm conditions because polyvalence enhanced PEf1 propagation in <i>P. putida</i>. In contrast, soil bacteria do not propagate coliphages and hindered T4 diffusion through the biofilm. Similar tests were also conducted under planktonic conditions to discern how interspecies competition contributes to <i>E. coli</i> suppression without the confounding effects of restricted phage diffusion. Significant synergistic suppression was observed by the combined effects of phages plus competing bacteria. T4 was slightly more effective in suppressing <i>E. coli</i> in these planktonic mixed cultures, even though PEf1 reached higher concentrations by reproducing also in <i>P. putida</i> (7.2 ± 0.4 vs 6.0 ± 1.0 log₁₀PFU/mL). Apparently, enhanced suppression by higher PEf1 propagation was offset by <i>P. putida</i> lysis, which decreased stress from interspecies competition relative to incubations with T4. In similar planktonic tests with more competing soil bacteria species, <i>P. putida</i> lysis was less critical in mitigating interspecies competition and PEf1 eliminated <i>E. coli</i> faster than T4 (36 vs 42 h). Overall, this study shows that polyvalent phages can propagate in soil bacteria and significantly enhance suppression of co-occurring enteric species

Tensile Characteristics and Fracture Mode of Frozen Fractured Rock Mass Based on Brazilian Splitting Test

Frozen fractured rock mass is often encountered during the implementation of geotechnical engineering in cold regions. The tensile strength parameters of frozen rock play an important role in the construction of rock slopes involving tensile failure. In order to study the tensile characteristics of a frozen fractured rock mass in a cold region, original rock specimens were mined and processed in the Yulong Copper Mine, and artificial, frozen fractured marble specimens were made. The effects of different ice-filled crack angles, lengths, and widths on the force&ndash;displacement curve and the tensile strength of frozen rock were studied by laboratory Brazilian splitting experiments and RFPA3D, and the evolution law of the tensile strength of frozen rock was revealed. At the same time, wing crack initiation and cracking mode after tensile failure were analyzed by high-speed camera; the whole process of the Brazilian splitting of frozen rock was reconstructed, and the development of microcrack initiation in frozen rock was analyzed. The following conclusions were drawn from the test results: the frozen rock specimens have typical brittle-failure characteristics. The tensile strength of frozen rock decreases gradually with the increase in the width and length of ice-filled cracks, and decreases first and then increases with the increase in the angle of the ice-filled crack. The ice-filled crack incurs damage first, and then the wing cracks start from the tip of the ice-filled crack and extend continuously. The tensile strength of frozen rock is significantly affected by the angle and length of ice-filled cracks

Optimal dispatching of electric‐heat‐hydrogen integrated energy system based on Stackelberg game

Abstract The interest conflict among entities in the integrated energy system (IES) has a great challenge to operation decisions of IES. With regards to this, an optimal dispatching model of electric‐heat‐hydrogen IES based on Stackelberg game is proposed. Firstly, an energy producer (EP) model is formulated which considered the full utilization of hydrogen energy and involved the conversion of hydrogen energy to electricity and heat energy. Meanwhile, the demand response amount is integrated into the objective function of load aggregator (LA) in order to encourage consumers to adjust their consumption behaviour. Secondly, by analyzing the characteristics of price information interaction among EP, energy system operator (ESO), and LA, the payoffs of each entity in IES are reformulated. Finally, a Stackelberg game model is established with ESO as the dominator guiding price information, EP and LA as the followers whose private information is confidential. Genetic algorithm and quadratic programming algorithm (GA‐QP) are employed to solve the developed model. Numerical experiments are carried out on an actual park‐level IES in northern China to demonstrate the effectiveness of the proposed model in promoting the benefit equilibrium among various entities

Phage Predation Promotes Filamentous Bacterium <i>Piscinibacter</i> Colonization and Improves Structural and Hydraulic Stability of Microbial Aggregates

Although bacteria–phage interactions have broad environmental applications and ecological implications, the influence of phage predation on bacterial aggregation and structural stability remains largely unexplored. Herein, we demonstrate that inefficient lytic phage predation can promote host filamentous bacterium Piscinibacter colonization onto non-host Thauera aggregates, improving the structural and hydraulic stability of the dual-species aggregates. Specifically, phage predation at 103–104 PFU/mL (i.e., multiplication of infection at 0.01–0.1) promoted initial Piscinibacter colonization by 10–15 folds and resulted in 29–31% higher abundance of Piscinibacter in the stabilized aggregates than that in the control aggregates without phage predation. Transcriptomic analysis revealed upregulated genes related to quorum sensing (by 15–92 folds) and polysaccharide secretion (by 10–90 folds) within the treated aggregates, which was consistent with 120–172% higher content of polysaccharides for the treated dual-species aggregates. Confocal laser scanning microscopic images further confirmed the increase of filamentous bacteria and polysaccharides (both with wider distribution) within the dual-species aggregates. Accordlingly, the aggregates’ structural strength (via atomic force microscopes) and shear resistance (via hydraulic stress tests) increased by 77 and 42%, respectively, relative to the control group. In the long-term experiments, the enhanced hydraulic stability of the treated aggregates could facilitate dwelling bacteria propagation in flow-through conditions. Overall, our study demonstrates that phage predation can promote bacterial aggregation and enhance aggregate structural stability, revealing the beneficial role of lytic phage predation on bacterial symbiosis and environmental adaptivity